Seeing Results

He might never have seen the building he was helping to build. He might never have seen his son. He might never have seen again—without the skills of a team of physicians at the USC Doheny Eye Institute.

When a container of fresh cement fell in front of construction worker Efren Zuniga, now 25, the chemicals in the cement burned his eyes so severely that his eyelids were melted and fused to his corneas.

“Examining Efren’s eyes was a little like looking at a cheese pizza. The various parts of the eye were so badly burned, it was difficult to determine where the eye began and the eyelids ended,” says Eli Chang, M.D., one of three Doheny physicians who combine their skills to help people recover from eye burns.

Team members are Chang, director of ophthalmic plastic/orbital surgery; Brian Francis, M.D., a glaucoma specialist; and Samuel C. Yiu, Ph.D., M.D., a corneal surgery specialist. Francis is associate professor, Chang and Yiu are assistant professors, all in ophthalmology at the Keck School of Medicine of USC.

Beautiful Progress  Back for a checkup, Zuniga smiles as Yiu exclaims during the examination, “This is awesome. Beautiful!”

“When we first saw him, he could only see light,” Yiu says. “He can navigate now. Before when he came in, he had to have a cane. Now he can maneuver.”

		Clearly Better Read more about Efren Zuniga. Full Story »

More than six surgeries were required in each eye over a period of three years after the 2004 accident. First Chang detached the eyelids from the corneas and transplanted tissue from the lip to reconstruct the inside of the eyelids.

“It was important for him to make room for us to work,” Yiu says of Chang’s role. “Without him, we couldn’t do anything.”

Emphasizing the importance of each member of the team, Chang responds, “I can make him look real nice, but without you guys, he can’t see.”

Because scar tissue prevents drainage of fluids from the eye, burn patients are in danger of pressure buildup and eventual blindness from glaucoma. Francis performed surgery to reduce fluid production.

Then Yiu replaced the corneas and transplanted healthy adult corneal stem cells obtained from an eye bank. Stem cells replenish the surface of the cornea on a regular basis. Like skin cells, corneal cells slough off every 72 hours, Yiu explains. “If I just do the corneal transplant and don’t do the stem cells, the cornea will fail. 

Working Together  “We thought it was a long shot, but we had three of us to work on this problem in consultation, instead of just one guy struggling,” Yiu says. In other settings, a patient might visit one specialist at a time, being referred from one to the other. Here, there are really four physicians on the team, including a rheumatologist, Shuntaro Shinada, M.D., to manage the anti-rejection medications that Zuniga must take.

“We’re always glad when patients like Efren come to us at the Doheny Burn Center, because most eye doctors don’t have the personal experience or a team of surgical colleagues onsite who are trained in all the disciplines necessary to get to work immediately to help such patients regain significant eyesight and function,” Chang says.

Although his eyesight is still blurry, Zuniga has been able to see his wife, Rosa. After the most recent surgery, he could see their 15-month-old son, Ismael, for the first time. And doctors expect his vision to continue to improve as his eyes continue to heal.

“I always was confident I would see,” Zuniga says. “God is powerful; there is nothing that is impossible.”